Rwanda's plan to extend Mutuelle to private hospitals hits a snag

Tuesday July 18 2017

Mutuelle de Sante card-holders wait at a

Mutuelle de Sante card-holders wait at a Rwandan hospital. PHOTO | FILE | NATION MEDIA GROUP

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The government’s plans to extend the coverage of the community health insurance (Mutuelle) to private health facilities remain in limbo as the low premiums charged are at odds with the cost of services outside the public health system.

Rwanda Social Security Board director-general James Gatera said a study had been commissioned to guide adjustments to the Mutuelle and RAMA (employee health insurance fund) scheme policies as the government seeks to deliver universal access to all levels of healthcare for citizens.

However, he could not disclose further details citing the sensitivity of the matter. But, he confirmed the scheme’s sustainability was one of the aspects under study and could inform possible policy change including the structure of premium.

“Any decision will have to be based on findings of a thorough study. It has been going on for a month now, so we cannot talk about it at this stage,” said Mr Gatera.

Sticking point

According to sources familiar with ongoing talks between the government and private health service providers, reconciling the cost of services at private health facilities and the static contributions to Mutuelle remains a major sticking point.

“We have been working with the government to come up with a kind of partnership that should allow Mutuelle patients to benefit from the infrastructure provided by the private hospitals and clinics. But, this is not something that can be done overnight.” said Partha Sarathy, an Indian investor and shareholder in Kigali-based Legacy Clinic.

Partha said the implementation of the plan still requires a public-private-partnership to facilitate accommodation of Mutuelle cardholders in private health facilities.

Private and for-profit healthcare providers account for just over 10 per cent of Rwanda’s healthcare system, but their state-of-the-art medical equipment, technology and specialist medical personnel make their services more preferred by medical insurance cardholders.

However, this excludes majority of the population, who are covered under the Mutuelle scheme who can only seek care from public health facilities.

The scheme runs largely on annual member premiums ranging from Rwf3,000 ($3.6), Rwf5,000 ($5.9) and Rwf7,000 ($8.3) depending on one’s socio-economic category, while the poorest are paid for by the government. These contributions are supplemented by transfers from private health insurance schemes, which contribute one per cent of their gross revenues to Mutuelle.

Mutuelle, which is now managed by the Rwanda Social Security Board (RSSB), is however yet to achieve financial stability and be self-sustaining due to reducing subscriptions and delayed settlement of bills by healthcare facilities.

The transfer of management to RSSB allowed members to seek healthcare at any public health facility across the country, thanks to the streamlining of management, which makes transfer of bills and funds more efficient.

The success of this informed the government to extend scheme members’ access to both public and private health facilities. But, players in the sector say this would require an upward revision of Mutuelle premiums or subsidies by the government.

“Mutuelle premiums are very low and the pool cannot afford the costs charged at private health clinics,” a source told Rwanda Today.